Provider Demographics
NPI:1417036112
Name:WASHKOWIAK, LISA JEAN (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JEAN
Last Name:WASHKOWIAK
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WESTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7006
Mailing Address - Country:US
Mailing Address - Phone:847-421-9004
Mailing Address - Fax:
Practice Address - Street 1:1315 WESTWOOD TRL
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:847-421-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146006741OtherSTATE LICENSE